AUTONOMICS Ma. Janetth B. Serrano, MD, DPBA. NERVOUS SYSTEM CENTRAL NERVOUS SYSTEM PERIPHERAL NERVOUS SYSTEM BRAIN SPINAL CORD EFFERENT Division AFFERENT

AUTONOMICAUTONOMICSS

Ma. Janetth B. Serrano, MD, Ma. Janetth B. Serrano, MD, DPBADPBA

NERVOUS NERVOUS SYSTEMSYSTEM

CENTRAL NERVOUS SYSTEM

PERIPHERAL NERVOUS SYSTEM

BRAINSPINAL CORDEFFEREN

T DivisionAFFERENT Division

AUTONOMIC N.S.

SOMATIC N.S.

Sympathetic N.S.

Parasympathetic N.S.

Enteric N.S.

NERVOUS NERVOUS SYSTEMSYSTEM

SOMATIC N.S.SOMATIC N.S.

• Skeletal, motor, Skeletal, motor, voluntary voluntary

• No ganglias or No ganglias or plexusesplexuses

• Motor n. to skeletal Motor n. to skeletal muscles muscles myelinatedmyelinated

• Interruption of Interruption of impulses impulses paralysis & atrophyparalysis & atrophy

AUTONOMIC N.S.AUTONOMIC N.S.

• Visceral, vegetative, Visceral, vegetative, involuntaryinvoluntary

• Efferent n. supply all Efferent n. supply all except skeletal m.except skeletal m.

• Peripheral ganglias & Peripheral ganglias & plexusesplexuses

• Postganglionic fibers Postganglionic fibers unmyelinatedunmyelinated

• Interruption of Interruption of transmission transmission spontaneous activityspontaneous activity

NEUROTRANSMITTERNEUROTRANSMITTERS:S:

•Sympathetic: ADRENERGICSympathetic: ADRENERGIC

Central: EPINEPHRINECentral: EPINEPHRINE Peripheral: NOREPINEPHRINEPeripheral: NOREPINEPHRINE

•Parasympathetic: Parasympathetic: CHOLINERGICCHOLINERGIC

AcetylcholineAcetylcholine

RECEPTORS:RECEPTORS:•Sympathetic: Sympathetic: ADRENOCEPTORSADRENOCEPTORS

Alpha Alpha αα1 1 , , αα2 2

Beta Beta 11 , , 22 , , 33

• Parasympathetic: Parasympathetic: CHOLINOCEPTORSCHOLINOCEPTORS

MuscarinicMuscarinic NicotinicNicotinic

• Dopaminergic: Dopaminergic: DD11, D, D22

RECEPTOR NAMERECEPTOR NAME TYPICAL LOCATIONSTYPICAL LOCATIONS RESULT OF LIGAND BINDINGRESULT OF LIGAND BINDING

Alpha 1Alpha 1 Postsynaptic effector Postsynaptic effector cells esp. smooth m.cells esp. smooth m.

Formation of IPFormation of IP33 and DAG and DAG

↑ ↑ IC calciumIC calcium

Alpha 2Alpha 2 Presynaptic adrenergic n. Presynaptic adrenergic n. terminals, platelets, terminals, platelets, lipocytes, sm.m.lipocytes, sm.m.

Inhibition of adenyl Inhibition of adenyl cyclasecyclase

↓ ↓ cAMPcAMP

Beta 1Beta 1 Postsynaptic effector Postsynaptic effector cells esp.heart, lipocytes, cells esp.heart, lipocytes, brainbrain

Presyn cholinergic & Presyn cholinergic & adrenergic terminalsadrenergic terminals

Stimulation of adenyl Stimulation of adenyl cyclasecyclase

↑ ↑ cAMPcAMP

Beta 2Beta 2 Posynaptic effector Posynaptic effector cells esp. sm. m. & cells esp. sm. m. & cardiac m.cardiac m.


↑ ↑ cAMPcAMP

Beta 3Beta 3 Postsynaptic effector Postsynaptic effector cells esp. lipocytescells esp. lipocytes


↑ ↑ cAMPcAMP

RECEPTOR NAMERECEPTOR NAME TYPICAL LOCATIONSTYPICAL LOCATIONS RESULT OF LIGAND BINDINGRESULT OF LIGAND BINDING

DD11 (DA (DA11), D), D55Brain, effector Brain, effector tissues esp. sm.m. of tissues esp. sm.m. of the renal vascular the renal vascular bedbed


↑ ↑ cAMPcAMP

DD22 (DA (DA22))Brain, effector Brain, effector tissues, esp. smooth tissues, esp. smooth m., presynaptic nerve m., presynaptic nerve terminalsterminals


↑ ↑ KK++ conductance conductance

DD33BrainBrain Inhibition of adenyl Inhibition of adenyl

cyclasecyclase

DD44Brain, Cardiovascular Brain, Cardiovascular SystemSystem


MUSCARINIC RECEPTORSMUSCARINIC RECEPTORSReceptor Receptor

TypeTypeLocationLocation Postreceptor Postreceptor

MechanismMechanism

MM11NervesNerves IPIP33, DAG cascade, DAG cascade

MM22Heart, nerves, Heart, nerves, smooth musclessmooth muscles

Inhibition of cAMP Inhibition of cAMP prod’n, activation of prod’n, activation of KK++ channels channels

MM33Glands, smooth Glands, smooth muscle, muscle, endotheliumendothelium

IPIP33, DAG cascade, DAG cascade

MM44? CNS? CNS Inhibition of cAMP Inhibition of cAMP

productionproduction

MM55? CNS? CNS IPIP33, DAG cascade, DAG cascade

NNMMSkeletal muscle NMJSkeletal muscle NMJ NaNa++, K, K++ depolarizing depolarizing

ion channelion channel

NNNNPostganglionic cell Postganglionic cell body, dendritesbody, dendrites

NaNa++, K, K++ depolarizing depolarizing ion channelion channel

SUMMARY OF SUMMARY OF NEUROHUMORAL NEUROHUMORAL

TRANSMISSION PROCESS:TRANSMISSION PROCESS:

I.I. Synthesis and Storage of Synthesis and Storage of NeurotransmitterNeurotransmitter

II.II. Release of NeurotransmitterRelease of Neurotransmitter

III.III. Interaction with Interaction with Postjunctional Cell and Postjunctional Cell and Initiation of ActivityInitiation of Activity

IV.IV. DeactivationDeactivation

EFFECTOR ORGANS

Autonomic Autonomic Nervous SystemNervous System


Some Sweat glds & some BV

RVSM

AcetylcholineAcetylcholine

Acetylcholine Dopamine

Nicotinic Receptor

Nicotinic Receptor

Muscarinic Receptor

D1 Receptor

Somatic Nervous System

Enteric Nervous Enteric Nervous System System

• Third division of the ANSThird division of the ANS

• Innervates GIT, pancreas, gallbladderInnervates GIT, pancreas, gallbladder

• Includes:Includes:

– Myenteric plexusMyenteric plexus

(Plexus of Auerbach)(Plexus of Auerbach)

– Submucous plexus Submucous plexus

(Plexus of Meissner)(Plexus of Meissner)


Effector Effector OrgansOrgans

ReceptorReceptor ActionAction

EyeEye

radial m. radial m. (iris) (iris)

ciliary m.ciliary m.

αα11

22

Contraction Contraction (mydriasis)(mydriasis)

RelaxationRelaxation

HeartHeart

SA nodeSA node

AV nodeAV node

ContractilityContractility

11

11

11

↑ ↑ Heart rateHeart rate

↑ ↑ conduction conduction velocityvelocity

↑ ↑ contractioncontraction

LungLung

bronchial m.bronchial m. 22 relaxationrelaxation

Sympathetic N. S.Sympathetic N. S.

Effector OrgansEffector Organs ReceptorReceptor ActionAction

Blood VesselsBlood Vessels

most BV most BV

skeletal m.skeletal m.αα11

22

ConstrictionConstriction


GITGIT

sphinctersphincter

motility & tonemotility & tone αα11

αα, , 22


DecreaseDecrease

GUTGUT

sphinctersphincter

bladder wallbladder wall

Penis, seminal v.Penis, seminal v.

αα11

22

αα11



EjaculationEjaculation

Sympathetic N. S.Sympathetic N. S.

Sympathetic N. S.Sympathetic N. S.Effector OrgansEffector Organs ReceptorReceptor ActionAction

Secretory glandsSecretory glands

sweatsweat

intestinalintestinal

bronchialbronchial

lacrimallacrimal

αα11

αα22

--

αα

Localized Localized secretionsecretion

InhibitionInhibition

--

Moderate Moderate secretionsecretion

MetabolismMetabolism

adrenal adrenal medullamedulla

kidneykidney

skeletal m.skeletal m.

Pancreas (B-Pancreas (B-cell)cell)

fat cellsfat cells

NNNN

11

22

αα22

33

Secretion of Secretion of cathecolamincathecolamineses

↑ ↑ renin releaserenin release

GlycogenolysisGlycogenolysis

↓ ↓ insulin insulin releaserelease

LipolysisLipolysis

Parasympathetic N. Parasympathetic N. S.S.Effector Effector OrgansOrgans

ReceptorReceptor ActionAction

EyeEye

circular m. circular m.

ciliary m.ciliary m.

MM33

MM33

Contraction Contraction (miosis)(miosis)

ContractionContraction

(accomodatio(accomodation)n)

HeartHeart

SA nodeSA node

AV nodeAV node

ContractilityContractility

MM22

MM22

MM22

↓ ↓ Heart rateHeart rate

↓ ↓ conduction conduction velocityvelocity

↓ ↓ contractioncontraction

LungLung

bronchial m.bronchial m. MM33 contractioncontraction

Effector OrgansEffector Organs ReceptorReceptor ActionAction

Blood VesselsBlood Vessels

most BV most BV

skeletal m.skeletal m.--

----

--

GITGIT

sphinctersphincter

motility & tonemotility & tone MM33

MM33


IncreaseIncrease

GUTGUT

trigone & trigone & sphincter m.sphincter m.

bladder wall & bladder wall & detrusor m.detrusor m.

Penis, seminal v.Penis, seminal v.

MM33

MM33

MM


IncreaseIncrease

ErectionErection

Parasympathetic N. Parasympathetic N. S.S.

Effector OrgansEffector Organs ReceptoReceptorr

ActionAction

Secretory glandsSecretory glands

sweatsweat

intestinalintestinal

bronchialbronchial

lacrimallacrimal

MM

MM33

MM

MM

Generalized Generalized secretionsecretion

↑ ↑ secretionsecretion

↑ ↑ secretionsecretion

Profuse Profuse secretionsecretion

Parasympathetic N. Parasympathetic N. S.S.

Parasympathetic Parasympathetic AgonistsAgonists

(Parasympathomime(Parasympathomimetics)tics)Direct-Acting Cholinoceptor Stimulants Direct-Acting Cholinoceptor Stimulants

(Choline Esters):(Choline Esters):A.A. Esters of Choline:Esters of Choline:

1. Acetylcholine1. Acetylcholine 3. Carbachol3. Carbachol

2. Metacholine2. Metacholine 4. Betanechol4. Betanechol

B. B. Alkaloids:Alkaloids:

1. Muscarinic1. Muscarinic

Muscarine, Pilocarpine, Muscarine, Pilocarpine, OxotremorineOxotremorine

2. Nicotinic2. Nicotinic

Nicotine, Lobeline, Nicotine, Lobeline,

Dimethylphenylpiperazinium Dimethylphenylpiperazinium (DMPP)(DMPP)

• AcetylcholineAcetylcholine– quarternary ammonium compoundquarternary ammonium compound– muscarinic & nicotinic activitymuscarinic & nicotinic activity– Actions:Actions:

• ↓ ↓ HR and CO, ↓ BPHR and CO, ↓ BP

• ↑ ↑ salivary & intestinal secretion and GI motilitysalivary & intestinal secretion and GI motility

• Enhances bronchiolar secretionsEnhances bronchiolar secretions

• ↑ ↑ detrussor muscle tonedetrussor muscle tone

• stim. Ciliary m. → near vivionstim. Ciliary m. → near vivion

• miosis miosis


(Parasympathomime(Parasympathomimetics)tics)Direct-Acting (Choline Esters):Direct-Acting (Choline Esters):


(Parasympathomime(Parasympathomimetics)tics)

Susceptibility Susceptibility to to

CholinesteraseCholinesterase

Muscarinic Muscarinic EffectsEffects

Nicotinic Nicotinic EffectsEffects

Therapeutic Therapeutic Use Use

AchAch ++ ++++++ ++++++ MioticMiotic

MetachoMetacho-line-line

++ ++++++++ ++ Dx of Dx of bronchial bronchial hyperactivityhyperactivity

Carba-Carba-cholchol

-- ++++++ ++++ MioticMiotic

Betane-Betane-cholchol

-- ++++ -- Non-Non-obstructive obstructive urinary urinary retentionretention

• Naturally-occuring:Naturally-occuring:– PilocarpinePilocarpine– ArecholineArecholine– MuscarineMuscarine



• PILOCARPINEPILOCARPINE– tertiary aminetertiary amine– dominant muscarinic actiondominant muscarinic action– resistant to acetylcholinesteraseresistant to acetylcholinesterase– Action: rapid miosis & contracts ciliary m.Action: rapid miosis & contracts ciliary m.

• Potent stimulator of secretions (sweat, tears, saliva)Potent stimulator of secretions (sweat, tears, saliva)

– Therapeutic Use:Therapeutic Use:• DOC in emergency lowering of IOP in glaucomaDOC in emergency lowering of IOP in glaucoma

– Adverse Effects: CNS disturbances, profuse sweating Adverse Effects: CNS disturbances, profuse sweating and salivationand salivation





• ARECOLINEARECOLINE

– chief alkaloid of areca or betel nutschief alkaloid of areca or betel nuts– muscarinic & nicotinic receptorsmuscarinic & nicotinic receptors– enhances salivary secretionenhances salivary secretion– no therapeutic indicationno therapeutic indication

Direct-Acting (Choline Esters):Direct-Acting (Choline Esters):



• MUSCARINEMUSCARINE– quarternary aminequarternary amine– muscarinic receptorsmuscarinic receptors– found in mushrooms found in mushrooms (Amanita muscaria)(Amanita muscaria)

– small amounts small amounts edible edible– large amounts large amounts poisonous poisonous

effects: fall in BP, temporary cessation effects: fall in BP, temporary cessation of heart beat, diaphoresisof heart beat, diaphoresis

– antidote: ATROPINE antidote: ATROPINE

Direct-Acting (Choline Esters):Direct-Acting (Choline Esters):



REVERSIBLE REVERSIBLE (Anticholinesterases)(Anticholinesterases)

Indirect-Acting :Indirect-Acting :

IRREVERSIBLEIRREVERSIBLE


(Parasympathomim(Parasympathomimetics)etics)

• REVERSIBLEREVERSIBLE (Anticholinesterases): (Anticholinesterases):• PhysostigminePhysostigmine• NeostigmineNeostigmine• PyridostigminePyridostigmine• AmeboniumAmebonium• EdrophoniumEdrophonium• Tacrine, Donezepil, Rivastigmine, Tacrine, Donezepil, Rivastigmine,

GalantamineGalantamine




• IRREVERSIBLEIRREVERSIBLE– Organophosphates Organophosphates

• IsoflurophateIsoflurophate• EchothiophateEchothiophate• Malathion, ParathionMalathion, Parathion

– Chemical WarfaresChemical Warfares• Sarin, SomanSarin, Soman




• PHYSOSTIGMINEPHYSOSTIGMINE– Alkaloid, tertiary amineAlkaloid, tertiary amine– Enters the CNSEnters the CNS– DOA: O.5 to 2 hrs.DOA: O.5 to 2 hrs.– Therapeutic Uses:Therapeutic Uses:

1.1. Atony of intestines and bladderAtony of intestines and bladder2.2. Glaucoma Glaucoma lowers IOP lowers IOP3.3. Antidote Antidote atropine, phenothiazines, TCA atropine, phenothiazines, TCA4.4. NDMR (tubocurarine) reversalNDMR (tubocurarine) reversal

– Adverse effects: convulsions, bradycardia, Adverse effects: convulsions, bradycardia, ↓ CO↓ CO

Indirect-Acting Indirect-Acting REVERSIBLE REVERSIBLE (Anticholinesterases):(Anticholinesterases):


(Parasympathomim(Parasympathomimetics)etics)NEOSTIGMINENEOSTIGMINE

– Quarternary nitrogenQuarternary nitrogen– Does not enter the CNS Does not enter the CNS peripheral peripheral– DOA: 0.5 to 2 hrsDOA: 0.5 to 2 hrs– Therapeutic Uses:Therapeutic Uses:

1.1. Atony of intestines and bladderAtony of intestines and bladder2.2. Myasthesia gravisMyasthesia gravis3.3. NDMR (tubocurarine) antidoteNDMR (tubocurarine) antidote

– Adverse effects: salivation, flushing, Adverse effects: salivation, flushing, ↓ BP, ↓ BP, nausea, abdominal pain, diarrhea, bronchospasmnausea, abdominal pain, diarrhea, bronchospasm



(Parasympathomim(Parasympathomimetics)etics)• PYRIDOSTIGMINE and PYRIDOSTIGMINE and

AMEBONIUMAMEBONIUM

– DOA: DOA: PYRIDOSTIGMINE - 3 to 6 hrsPYRIDOSTIGMINE - 3 to 6 hrsAMEBONIUM – 4 to 8 hrsAMEBONIUM – 4 to 8 hrs

– Therapeutic Uses:Therapeutic Uses:1.1. Myasthesia gravisMyasthesia gravis2.2. NDMR (tubocurarine) antidoteNDMR (tubocurarine) antidote

– Adverse effects: salivation, flushing, Adverse effects: salivation, flushing, ↓ BP, ↓ BP, nausea, abdominal pain, diarrhea, nausea, abdominal pain, diarrhea, bronchospasmbronchospasm




• EDROPHONIUM EDROPHONIUM – Quarternary amineQuarternary amine– DOA: DOA: 5 to 15 mins5 to 15 mins– Therapeutic Uses:Therapeutic Uses:

1.1. Diagnosis of Myasthesia gravisDiagnosis of Myasthesia gravis2.2. NDMR (tubocurarine) antidoteNDMR (tubocurarine) antidote3.3. Arrhythmias (SVT)Arrhythmias (SVT)

– Antidote: Antidote: AtropineAtropine– Adverse effects: salivation, flushing, Adverse effects: salivation, flushing, ↓ BP, ↓ BP,

nausea, abdominal pain, diarrhea, bronchospasmnausea, abdominal pain, diarrhea, bronchospasm




• Tacrine, Donezepil, Tacrine, Donezepil, Rivastigmine, GalantamineRivastigmine, Galantamine

– Alzheimer disease Alzheimer disease deficiency of deficiency of cholinergic neurons in the CNScholinergic neurons in the CNS

– TacrineTacrine – hepatotoxic – hepatotoxic– Adverse effect: GI distressAdverse effect: GI distress




A.A.ORGANOPHOSPHATESORGANOPHOSPHATES ISOFLUROPHATEISOFLUROPHATE

- tx of open angle glauctx of open angle glaucomaoma

ECHOTHIOPHATEECHOTHIOPHATE- Produce intense miosis Produce intense miosis tx of open tx of open

angle glaucangle glaucomaoma

PARATHION, MALATHIONPARATHION, MALATHION- InsecticidesInsecticides

Indirect-Acting Indirect-Acting IRIRREVERSIBLE :REVERSIBLE :


(Parasympathomim(Parasympathomimetics)etics)• ORGANOPHOSPHATE POISONING:ORGANOPHOSPHATE POISONING:

– Signs:Signs:1. 1. miosismiosis2. salivation, frothy secretions2. salivation, frothy secretions3. sweating3. sweating4. bronchial constriction4. bronchial constriction5. vomiting and diarrhea5. vomiting and diarrhea6. muscle fasciculation6. muscle fasciculation

ORGANOPHOSPHATE ORGANOPHOSPHATE POISONING:POISONING:

Therapy:Therapy: maintenance of VS maintenance of VS respiration respiration DecontaminationDecontamination Drugs: Atropine + Pralidoxime Drugs: Atropine + Pralidoxime

ATROPINE sulfateATROPINE sulfate 1 to 2 mg IV every 1 to 2 mg IV every 5-5- 15 min until signs of effect 15 min until signs of effect appears appears (maximum of 1 gm per (maximum of 1 gm per day)day)PRALIDOXIMEPRALIDOXIME A cholinesterase A cholinesterase enzymeenzyme regenerator compoundregenerator compound

- 1 to 2 gm given over 30 min - 1 to 2 gm given over 30 min by IV by IV infusioninfusion

Parasympathetic Parasympathetic Agonists Agonists


• ANTIMUSCARINICSANTIMUSCARINICS– Tertiary Amines:Tertiary Amines:

a.a. Natural – atropine, scopolamineNatural – atropine, scopolamine

b.b. Semisynthetic – tropine, homatropineSemisynthetic – tropine, homatropine

c.c. Synthetic – dicyclomine, oxybutyrine, Synthetic – dicyclomine, oxybutyrine, oxyphencyclimineoxyphencyclimine

– Quarternary Amines:Quarternary Amines:a.a. AnisotropineAnisotropine

b.b. PropanthelinePropantheline

c.c. MethantelineMethanteline

Parasympathetic Parasympathetic AntagonistsAntagonists

(Parasympatholytic(Parasympatholytics)s)



•ATROPINEATROPINE– prototypeprototype– Belladona alkaloidBelladona alkaloid– high affinity for muscarinic receptorshigh affinity for muscarinic receptors– central and peripheral muscarinic blockercentral and peripheral muscarinic blocker

causes reversible (surmountable) blockade causes reversible (surmountable) blockade of the actions of cholinomimetics at of the actions of cholinomimetics at

muscarinic receptorsmuscarinic receptors

Unopposed sympathetic actionUnopposed sympathetic action



• Actions:Actions:

1. CNS1. CNS

– – minimal stimulant effectminimal stimulant effect

2. Eye 2. Eye

- mydriasis, unresponsiveness to - mydriasis, unresponsiveness to lightlight

- - cycloplegiacycloplegia inability to focus inability to focus for near-visionfor near-vision


(Parasympatholytic(Parasympatholytics)s)ATROPINEATROPINE


(Parasympatholytic(Parasympatholytics)s)• Actions:Actions:

3. GIT3. GIT

- antispasmodic - antispasmodic reduce GIT activity reduce GIT activity

4. GUT4. GUT

- reduce urinary bladder hypermotility - reduce urinary bladder hypermotility

5. SECRETIONS5. SECRETIONS

- blocks salivary glands - blocks salivary glands antisialogogue antisialogogue

- decrease also lacrimal & sweat glands - decrease also lacrimal & sweat glands

secretionsecretion

ATROPINEATROPINE



• Actions:Actions:

6. CVS6. CVS

- divergent effects - divergent effects depending on dosedepending on dose

Low dose – (-) MLow dose – (-) M11 ↑ ↑

Ach releaseAch release

Higher dose – (-) MHigher dose – (-) M22 on on

SA node SA node ↑ CR ↑ CR

Effects in relation to dose:Effects in relation to dose:DoseDose EffectsEffects



0.5 mg0.5 mg Slight cardiac slowing Slight cardiac slowing

some dryness of mouth some dryness of mouth

inhibition of sweatinginhibition of sweating

1.0 mg1.0 mg Definite dryness of mouth; Definite dryness of mouth; thirst acceleration of heart, thirst acceleration of heart, sometimes preceded by sometimes preceded by slowingslowing

mild pupillodilatationmild pupillodilatation

DoseDose EffectsEffects



2.0 mg2.0 mg Rapid HR; palpitations Rapid HR; palpitations

marked dryness of mouth marked dryness of mouth

Dilated pupils; some blurring of Dilated pupils; some blurring of visionvision5.0 mg5.0 mg All of the above symptoms marked; All of the above symptoms marked; difficulty in speaking and difficulty in speaking and swallowing;swallowing;

Restlessness and fatigue;Restlessness and fatigue;

Headache; dry, hot skinHeadache; dry, hot skin

Difficulty in micturitionDifficulty in micturition

Reduced intestinal peristalsisReduced intestinal peristalsis



DoseDose EffectsEffects

ATROPINEATROPINE

10.0 mg 10.0 mg and and moremore

Above symptoms more markedAbove symptoms more marked

Pulse rapid and weakPulse rapid and weak

Iris practically obliteratedIris practically obliterated

Vision very blurredVision very blurred

Skin flushed, hot, dry, and scarletSkin flushed, hot, dry, and scarlet

Ataxia, restlessness and Ataxia, restlessness and excitementexcitement

Halluciantions and deliriumHalluciantions and delirium

ComaComa

• Therapeutic Uses:Therapeutic Uses:1. Ophthalmic1. Ophthalmic- Permits measurement of EOR Permits measurement of EOR 2. Antispasmodic2. Antispasmodic3. Antidote for cholinergic agonists3. Antidote for cholinergic agonists- Organophosphate poisoningOrganophosphate poisoning- Mushroom poisoningMushroom poisoning- acetylcholinesterase inhibitorsacetylcholinesterase inhibitors4. Antisecretory agent4. Antisecretory agent




(Parasympatholytic(Parasympatholytics)s)SCOPOLAMINESCOPOLAMINE

• Belladona alkaloidBelladona alkaloid

• Peripheral effects similar to atropinePeripheral effects similar to atropine

• Greater and longer CNS actionGreater and longer CNS action

• Action:Action:– Anti-motion sicknessAnti-motion sickness– Blocks short-term memoryBlocks short-term memory– Produces sedation, Produces sedation,

excitementexcitement

• Therapeutic Uses:Therapeutic Uses:

– anti-motion sicknessanti-motion sickness– adjunct in anesthesia procedures adjunct in anesthesia procedures

> in obstetrics, + morphine > in obstetrics, + morphine sedation sedation

& amnesia & amnesia


(Parasympatholytic(Parasympatholytics)s)SCOPOLAMINESCOPOLAMINE

• Quarternary derivative of Quarternary derivative of atropineatropine

• Does not enter CNS Does not enter CNS

• Therapeutic Uses:Therapeutic Uses:– Treat asthma in patients who are Treat asthma in patients who are

unable to take adrenergic agonistsunable to take adrenergic agonists– Management of COPDManagement of COPD


(Parasympatholytic(Parasympatholytics)s)IPATROPIUMIPATROPIUM

• Specifically act on NICOTINIC Specifically act on NICOTINIC receptorsreceptors

• No selectivity towards PNS or No selectivity towards PNS or SNSSNS

• Blocks entire ANS outputBlocks entire ANS output

• Non-depolarizing, competetive Non-depolarizing, competetive antagonists antagonists except NICOTINEexcept NICOTINE


(Parasympatholytic(Parasympatholytics)s)GANGLIONIC BLOCKERSGANGLIONIC BLOCKERS

A.A. NICOTINENICOTINE

B.B. TRIMETHAPHAN TRIMETHAPHAN

C.C. MECAMYLAMINE MECAMYLAMINE

D.D. HEXAMETHONIUM HEXAMETHONIUM



A. NICOTINEA. NICOTINE• Low dose :Low dose :

ganglionic stimulation by depolarization ganglionic stimulation by depolarization CNS: euphoria, arousal, relaxationCNS: euphoria, arousal, relaxation

improves attention, learning, improves attention, learning, problem solving & reaction timeproblem solving & reaction time

Peripheral: Peripheral: ↑ BP & HR, vasoconstriction↑ BP & HR, vasoconstriction

• High dose High dose ganglionic blockade ganglionic blockade BP falls, blocks GIT & bladder activityBP falls, blocks GIT & bladder activity



“ “ Sunset in one landSunset in one land … …

Means sunrise in another.”Means sunrise in another.”

Documents

AUTONOMICS Ma. Janetth B. Serrano, MD, DPBA. NERVOUS SYSTEM CENTRAL NERVOUS SYSTEM PERIPHERAL NERVOUS SYSTEM BRAIN SPINAL CORD EFFERENT Division AFFERENT